9811-060 (RPL)N CO
W
o � co
�w�
tilYr
Z
CID
O_,
0
W W
H a -
U)
Z
LICENSED CONTRACTOR DECLARATION
ffirm under penalty of perjury that I am licensed under provisions of
(commencing with Section 7000) of Division 3 of the Business and
als Code, and my License is in full force and effect.
Lic: Class Exp. Date
_M768 C53 B 12/31NK)
Signature,of Contractor r�T
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of'perjury'that I am exempt from the Contractor's
License. Law for the following reason:
( ) I, as owner of the property, or my employees with wages as, their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044; Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
perforTance of the work for which this permit is issued.
1 have and will maintain workers' compensation insurance;, as required by
ection 3700 of the Labor Code, .for the performance of the work for which this
permit is issued.. My workers' compensation insurance carver & policy no. are:
Carrier Policy No.
:r,trE FUND
(This section need notbe completed if the permit valuation is for $100.00 or less).
( ) I certify that.in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those p visions,,-
Date:
isionsDate: Applicant`
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,600, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and.attomey's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each personrat'l
whose request and for whose benefit work is performed under or pursuant'to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit,, or cessation of work for 180 days will subject permit to cancellation.
I certify that`I have read this application and state that the above information is
Corr . 1 agree to comply with all City, and State laws relating to the building
pohstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectionpurposes.
Signature (Owner/Agent) e, Date
BUILDING. PERMIT PERMIT+r
DATE VALUATION 0..8 rf�® LOT87 TRACT
JOB SITE! t,�t!�
ADDRESS 52.180 DFL lDJU iH
GAYO
APN
-
OWNER
S K
CONTRACTOR / DESIGNER LENGINEER
(Q cid a r
`
5, -iso DEL C: VID Oki VE
43375 NUU)IS014 IST
LA OUI NT:A. CA 92243
IRIDIC► CA 02202
{7F+Ol t47_ .�tig (7101.# 1 15.1
USE OF PERMIT
P001'. ANC)IOR SPA
P00i.J&Pik, AL Alti1-iSMARRUI-k$ Si- ALA. E W AT iykGG •'I.ASTIIf
ItJ'hNd?C-'l'icJfd
1001, A; WOR SPA. L
.LL, �1i nttl'I,t'l�Y bL�J cos or, cam•ruc- ioN.
PEK'AIiT N'IRW s+rrMrtii'ARY
P1.A AN C.:HFXK ]"C -E 101 -WO -439-318 51630.84)
(7QN, rK1_f^Tf0NFRE 10!4)%)-484-000 0-484-000 $^5^(10
MECHANICAL FIT.,.... POOL 101-000-421-000
0-E 7• UCAL I'EE-- 1-1k� iol-,K)0-420-000
f'LUMf3Rdc T—U •- Vcx.A., 101 -OW -41,94,100 527:iut
S rB=ppprtrrq�YfAl: +'ONSTRI � ,. IONJ AND CHl 'alb
�tn
�f,,T1AM
PIS 112'tf.'-tI iiiI FELE i
lit
q.13 00
f0TAt Q'S R.M.l'C.l+FCS 01 IV NOW
`511JNJ
Nov Q 9 1998
17
rJ'A
rIllyRy CEIPT
D^E� �� !
JB?f� ,
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms'& Footings
Ducts
Slab Grade
Return Air
steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
•
Framing
Compressor
Insulation
Vents
•
Fireplace P.L.
Grills.
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
.Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Under round Plbg. Test
Final
S PE
PLUMBING APPROVALS
Ga •
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
.
Plumbing Top'qut
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
.
Gas Test
Appliances
•
09
Final Z
'
.•
'
•
-
•
C,9 NTSCG
-
Final
U61ity Notice (Gas)
ELECTRICAL APPROVALS
-Temp. Power Pole.
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
'Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility-Nbbce.(Perm)
SKA L A K - 1. OT 8 7
,
25 P
69•�� N. 62' �0
�RooF n
��fA�y� r�
I _ 6
n
w
a
.gyp
Aa. -tv"
bF4,a4ra Pk*
cvwf
�- ... DRAI
2 3, �
6pg J EAST
ca Rom DRAIN 0 .. Ile
\�
o�.
,off'• 650
D• 6� .o
• ti.
Op
6
62.5
6lot
F v
62. p�
01
.. _ P/L
0 3 F
WAU-_-PER Q B.S.L.I
R _ - � yt/�
RETI'LANTEPLANS
ARCM�CTS o�.
'oq0.• 6 000 ?Or
{
19 FS POOL (n
6
p \ � 26
6 62 9
.�P I 11~ Q 32 fl liY I EDGE
P IN
r L PER
RPLANTERPLANS SPILL
CHINC.RS DRAIN 3 OVER a
AR 1 O
.a
or �--
AISED
k � SP A o
64
6 F5 6�°F5
RW DRAW
ROOF DRAIN
FS I
o°
—}-- 69'��I 9' J 4' pvc
AC 1 4• PVC S.Q,O1
S+•Q.01 �► � 60 J t
50 � - 3 1
MIN. 62. P .5 ( G
39 IN`s F�'� 62 NP
62.
9 m (l
At 5 o'ti
N
uc. a
3UM •
0
69� P.o. Box 1 o47 43 375 Madison St. Indio, CA 92201
(619),347-5959